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Friday, July 4, 2014

Pregnancy & Breastfeeding Nutrition Guide

Do you know what your body needs for calories and nutrients when you're pregnant or nursing?

If you're planning a family, have a baby on the way, or are nursing, it's important to know and understand what your body needs. Adding calories isn't an excuse to meet more chips (sorry ladies!) or chow down on your favourite naughty snacks 'just because'. To help you learn what to eat to encourage a healthy pregnancy, a healthy baby, & a healthy mama, we spoke to dietician, Kristy Pemberton. Here's what she had to say...

Pregnancy

Calorie requirements increase in pregnancy by about 10 - 15
percent. If you think of this in food terms, it is only about 200- 300extra calories or an extra large snack (e.g. one sandwich, or
pot of yoghurtand handful of nuts).
So ‘eating for two’ is not an excuse to eat what you want, in fact eating too
much can increase risks of gestational diabetes.

Calorie needs can be
broken down per trimester :

First trimester no increase in needs

Second
trimester: about 340 calories extra(2 small
snacks)

Third trimester: about 450 calories extra (small meal).

Calorie needs increase due to the increase in
metabolic rate and the needs of the growing baby.The further along in your pregnancy the more
calories you need. However this is partially offset by fat stores laid down in
early pregnancy and the lack of activity in later pregnancy.The body is pretty adaptive and optimal
weight gain has been achieved with less than optimal calorie intakes (e.g.
morning sickness etc).

Breastfeeding

There is an increase in calorie requirements during
breastfeeding because of the need to produce breast milk. Calorie requirements
tend to increase over the first six months of baby’s lifeas breast milk increases. The average extra daily energy requirement for breastfeeding 475–500 calories
per day. However even if your calorie intake does not increase, breast milk
tends to remain adequate.Because the
nutrition status of the mother only has a small effect on the amount and
make-up of breast milk the sufficiency of breast milk supply should be judged
by baby’s growth and development, not on what the mother is eating.

If there is any concern that the supply is not
enough please talk to your midwife or doctor about what can be done.It is important that women understand the
relationship between infant demand and milk production so that they do not
introduce infant formula unnecessarily.Well nourished women often have fat stores that are a good source of
energy to support adequate breast milk. On average a woman will lose
approximately 800g per month for the first 6 months of breast feeding.Demand-fed infants effectively regulate their
energy intake (and milk volume), so the volume a baby drinks depends on milk
concentration.

It is not wise for a
breast feeding woman to go on a calorie restricted diet(e.g. less than 1800 calories) to lose weight
as some studies have shown this can reduce breast milk volume, especially in
already lean women (however concentration was not looked at). Women need to
allow adequate time to readjust after pregnancy, and weight loss after delivery
to pre- pregnancy weight should not be expected to occur before 9–12 months.

Weight Gain

There is no calorie level that women should eat, as it
varies widely between individuals and very few people ‘count calories’.Rather we want to eat enough to achieve
optimal weight gain.This is based
loosely on body mass index (see the guidelines below). If you are gaining a lot
of weight this can predispose some women to gestational diabetes and if not
enough weight is gained it can impair the growth of the baby.Weight gains outside the Institute of Medicine’s suggested ranges are associated with double
the number of poor pregnancy outcomes as weight gains within the ranges.

Body Mass Index

Recommended weight gain

Less than 19.9

12 - 18kg

Between 20 and 26

11.5kg – 16kg

Between 26 - 29

7 -11 kg

Over 29

6

Source: Institute of Medicine 1990.

The recommended rate of gain is approximately 0.4 kg/week
in the second and third trimesters; for women with a lower BMI it is
approximately 0.5 kg/week; and for women who are overweightit is approximately 0.3 kg/week. This is only
a guideline and it is common for women to gain weight slower or faster than
this.

What to Eat

When pregnant it is important to follow a healthy diet that
is relatively low in sugar, saturated fat, and salt, and to avoid too much processed
foods.When cooking, follow healthy
cooking guidelines such as removing fat from meat, grilling, steaming or baking
instead of frying; avoid adding too much extra salt and sugar, etc. Here are some healthy eating guidelines:

1) Choose at least six servings of breads and cereals each
day

e.g.1 slice of wholegrain bread, 1 cup of pasta
or rice, ½ of cereal or muesli, try other grains such as quinoa, lentils etc.

These provide carbohydrates (sugar and starch), fibre, and
nutrients such as B vitamins and minerals. Women who are pregnant should not be
on a low carbohydrate diet.

• Eat plenty of breads and cereals, including rice, pasta,
breakfast cereals and other

grain products.

• Choose wholegrain varieties because they provide extra
nutrients and fibre. They

also help prevent constipation.

2) Have at least three servings each day of milk or milk
products, preferably reduced- or low-fat products.

e.g. 1 glass of milk,2 slices of hard cheese, pot of yoghurt
(150g)

Calcium requirements are higher
in pregnancy and breastfeeding. Pregnant
women require milk and milk products as sources of protein, vitamins and minerals,
especially calcium and iodine.

• Choose reduced- or low-fat milk, yoghurt and hard cheese.

• Milk and milk products provide most of people's calcium.
If you do not eat these foods or eat very little of them, ask your doctor or
dietitian about other calcium sources.

• Calcium is also found (in lower amounts) in foods such as
wholegrain bread,

broccoli, canned salmon, sardines, spinach, baked beans, and
tofu.

• If you are drinking soy milk, choose one that is
calcium-fortified (check the label).

These foods give you protein,
iron, zinc, and other nutrients which you need more of during pregnancy. Iron is important for healthy blood and for
the development of your baby. During pregnancy, it is important to have enough
iron to prevent iron deficiency or anaemia. Iron found in lean meats, chicken and seafood
is absorbed well by the body (haem iron). However eggs, beans, peas and lentils, and
nuts and seeds have a form of iron that is not as easily absorbed (non-haem).

Having foods high in vitamin C (broccoli, tomatoes, oranges, kiwifruit, mango,
pineapple)with your meals will help to absorb
non haem iron. This is especially important for vegetarian and vegan women, who
can find it hard to get enough iron. Liver is a good source of iron, but eat no
more than a small piece (100 g) once a week as it is high in Vitamin A.

Requirements of iodine are also
higher in pregnancy; you can take a supplement that contains iodine especially
for pregnant women. Seafood and eggs are also useful sources of iodine.

Fish is recommended 2 – 3 times
a week because it is a source of omega -3s, which are important for baby’s brain
development.

Food
safety when choosing fish and seafood: High intakes of mercury are unsafe for your
baby. Some fish have higher levels of mercury, although there is little concern
with canned tuna, canned salmon, mackerel or sardines, farmed salmon, tarakihi, blue
cod, hoki, john dory, monkfish, and flat
fish like flounder. Fish that have higher levels of mercery (longer-lived and
larger fish) include: uncanned wild-caught (not farmed) salmon, uncanned
albacore tuna or mackerel, kahawai, red cod, orange roughy and ling can contain more mercury, so consumption of these should be limited to three
150 g servings per week.

A small number of fish (eg, school shark,
southern bluefin tuna, marlin, and trout) should be eaten only once a fortnight – or not at all if consuming
other types of fish or seafood.

If you don’t like fish you can
take fish oil, but make sure it is a good quality one that has been tested for
mercury and don’t exceed the guidelines on the bottle.

4) Drink Plenty
of Fluids Every Day -Aim for eight to nine
cups of fluid each day.

Extra fluid may be needed during hot weather, after
activity, or if you are vomiting or constipated.

Water or reduced- or low-fat milk are the best choices.

Be aware that caffeine consumption may affect your baby’s
growth during pregnancy. Caffeine is naturally occurring in tea, coffee, and chocolate
and is present in many cola-type or energy drinks. Watch the amount of caffeinated
drinks you are consuming while pregnant. No more than six cups of tea or instant
coffee, or three single shot espressos, or one double shot espresso coffee.Also be careful with herbal teas; some can
have an effect on hormone levels. Tea should be consumed away from meals as
it reduces your ability to absorb iron from your food.Limit soft drinks, flavoured waters, fruit
drinks, cordials, and diet drinks because these are low in nutrients and may be
high in sugar.

Special Concerns:

If someone has any of the below conditions they should ask to talk to a dietitian:

• are 18 years old or younger

• have a medical condition affecting their eating, such as diabetes

• are having more than one baby (eg, twins or triplets)

• eat very little or have a history of eating problems

• are vegetarian or vegan.Kristy Pemberton is a dietician living in New Zealand. With her husband Nigel, they have travelled all over the world and continue their globetrotting through work and pleasure.If you found this post helpful & informative, please leave a comment below! We would love to have Kristy back with more great nutrition articles!